stroke

Stroke: Everything You Should Know

A stroke is often referred to as a “brain attack,” cutting off blood and oxygen to the brain cells that control everything we do, from speaking, to walking, to breathing. Most strokes occur when arteries are blocked by blood clots or by the build-up of plaque and other fatty deposits.

Some strokes are caused when weak spots on the blood vessel wall break and rupture arteries. Brain tissue needs a constant supply of oxygen and nutrients to function correctly. When the tissue is cut off from oxygen during a stroke, the tissue begins to die.

Every year stroke strikes approximately 750,000 Americans – killing 160,000, and forever changing the lives of many who survive. For people over 55, the risk of a stroke is greater than one in six. A stroke can cause permanent disability and even death. In fact, it is the third-leading cause of death in America, and the number one cause of disability.

The good news is that many strokes can be prevented. If you do have a stroke, new treatments may help stop brain damage and disability (if administered within three hours of the first sign of a stroke). Once you recognize the signs, you should call 9-1-1 immediately.

Types of Strokes

  • Hemorrhagic Stroke is the most serious. This type occurs when a blood vessel in the brain ruptures. Hemorrhage can occur in several ways. One common way is a weak spot in an artery wall that stretches or balloons out under pressure and eventually ruptures. It can also occur when the arterial wall breaks open, due to plaque or fatty deposit build-up.
  • Ischemic Stroke occurs when a blood vessel in the brain becomes blocked, suddenly decreasing or stopping blood flow and causing brain damage. Blood clots are the most common cause of an ischemic stroke. This type of stroke accounts for 80 percent of all strokes.
  • Transient Ischemic Attack (TIA), also known as a “mini-stroke,” occurs when the blood flow to part of the brain is cut off for a short period of time, usually less than 15 minutes. A TIA is a warning sign and should be treated seriously. Of the approximately 50,000 Americans that have a TIA each year, about one-third will have a stroke in the near future. So, if you experience the symptoms of a stroke for only a short period of time, then the symptoms go away, you may be having a “mini stroke.” Although a TIA may not leave noticeable damage, it is important to talk to your doctor immediately.

Common signs of a stroke include

  • Sudden numbness or weakness of the face, arm or leg – especially on one side of the body
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance, or coordination
  • Sudden severe headache with no known cause
  • Sudden confusion or trouble speaking

Learning them – and knowing what to do when they occur – could save your life.

A stroke is a medical emergency. If you experience any of the above signs or symptoms, call 9-1-1 immediately. Treatment can be more effective if you receive it early on. Every second counts!

To help prevent stroke follow the ABCs

  • Aspirin: take an aspirin a day. It is very important to talk to your doctor about the correct dosage BEFORE starting.
  • Blood Pressure: Keep your blood pressure under 140/90. See your health care provider and follow his recommendations.
  • Cholesterol: Remind your health care provider to test your cholesterol level and follow their directions.
  • Smoking Cessation: Stop smoking; there are many aids to help you stop smoking. Contact your health care provider for help, or visit www.utahquitnet.com or call Utah Tobacco Quit Line toll-free at 1-800-QUIT-NOW.

Risk Factors

stroke risk factors

Am I at risk for a stroke? Everyone has some risk for stroke. Many risk factors are preventable or can be controlled but a few stroke risk factors are beyond your control.

Risk factors you cannot change

  • Increasing age: People over age 55 are at greater risk of stroke.
  • Gender: More men than women have strokes in certain age groups, but more women actually die from stroke.
  • Race: African-Americans and Hispanics have a higher risk of death and disability from stroke.
  • Heredity: A family history of stroke can increase your risk. The Family Health History Toolkit is a great resource for collecting your family health history.
  • Previous Stroke: History of a previous stroke may increase stroke risk by up to 10 times.
    Previous episode of Transient Ischemic Attack or TIA (“mini-stroke”).
  • Heart Disease
  • Atrial Fibrillation: An abnormal heart rate or rhythm. This type of irregular heartbeat occurs in 15 percent of all strokes. Learn more about atrial fibrillation and what you can do to decrease your risk.
  • Carotid Artery Disease: The narrowing or blocking of the carotid arteries by cholesterol called plaque. Carotid Artery Disease puts you at an increased risk for stroke because a piece of the plaque can break free and travel to the brain where it blocks a vessel in the brain.

Risk factors you can change

High Blood Cholesterol

Cholesterol is a soft, fat-like substance in your body. Cholesterol comes only from animal products or animal by-products such as beef, chicken, eggs, milk, etc. A high level of cholesterol in the blood (240 mg/dL or higher) is a major risk factor for heart attack and also increases your risk of having a stroke. High levels of HDL (“good”) cholesterol lower your risk of heart disease and stroke. People with a low level of HDL cholesterol (<40 mg/dL) have a higher risk of heart attack and stroke. A high LDL level, more than 160 mg/dL (130 mg/dL or above if you have two or more risk factors for heart disease), reflects an increased risk of stroke. That’s why LDL cholesterol is often called “bad” cholesterol.

High Blood Pressure (hypertension)

High blood pressure causes the heart to work harder, putting you at an increased risk for heart attack, stroke, heart failure, kidney, and eye problems. There are no symptoms to identify high blood pressure and therefore many people are unaware that they have it. The only way to detect high blood pressure is to have it checked regularly.

Smoking

Quitting smoking lowers a person’s risk of stroke greatly, even after many years of smoking. Learn more about the impact of smoking on stroke.

Diabetes

Two out of three people with diabetes die from heart disease or stroke. Diabetes is a chronic metabolic disorder affecting the body’s ability to make or use insulin. Insulin is the hormone that transports glucose (blood sugar) from digested nutrients into the body’s cells for energy and growth. There are two types of diabetes, type 1 and type 2. When the body cannot produce insulin, this is called type 1 diabetes. In order to control their blood sugar, the patient must use insulin injections. In type 2 diabetes, the body produces insulin but is unable to process it and/or use it correctly in most cases this may be controlled by diet and exercise. If you are diabetic, following your doctor’s recommendations helps you maintain control and lessens your risk for stroke. Learn more about diabetes.

Physical Inactivity

Physical inactivity increases your risk of heart disease and stroke. You can reduce your risk by doing moderate-intensity physical activity for a total of 2 ½ hours per week.

Obesity

Obesity is the second leading cause of preventable death in the United States. Only smoking exceeds obesity in contributing to the total U.S. death rate. The percentage of overweight or obese persons in Utah and the U.S. has increased dramatically over the past 10 years. Adults who are obese are also at a greater risk of high blood pressure, high cholesterol, diabetes, coronary heart disease, stroke, osteoarthritis, sleep apnea, respiratory problems, and endometrial, breast, prostate, and colon cancer.

Contributing Factors for Stroke

Researchers continually discover other factors that seem to relate to stroke. The following are a few of these factors:

  • Alcohol
  • Stress

Stroke Treatment and Rehabilitation

stroke treatment
Headache area on brain X-ray, 3D illustration.

Until recently, stroke treatment was restricted to basic life support at the time of the stroke and rehabilitation later. Now, several treatments options are available, and if treated early enough they can help stroke victims avoid death or disability.

Treatment options during a stroke

Medication or Drug Therapy

Medication or drug therapy is the most common treatment for a stroke. The only drug currently approved by the Food and Drug Administration (FDA) to treat ischemic stroke is a thrombolytic agent called tissue Plasminogen Activator (tPA). This is often referred to as “clot buster” medication. tPA must be given within the first three hours of the first sign of a stroke. This is why it is important to seek medical help immediately!

Mechanical Therapy

Mechanical therapies to remove blood clots and restore flow are a new approach to the treatment of ischemic stroke. The FDA recently cleared the Merci Retriever, a device from Concentric Medical that removes blood clots from patients experiencing an ischemic stroke. The device is navigated into the brain using standard catheterization techniques. A small puncture in the groin is made to introduce the Merci Retriever into an artery leading to the brain. Upon reaching the targeted area, the Merci Retriever is designed to restore blood flow by engaging, capturing, and removing the blood clot.

Preventive treatment

  • Anticoagulants/Antiplatelets – Antiplatelet agents such as aspirin and anticoagulants such as warfarin interfere with the blood’s ability to clot and can play an important role in preventing stroke. Please check with your doctor before starting any medications.
  • Carotid Endarterectomy – A carotid endarterectomy is a surgical removal of plaque (or fatty buildup) from the carotid artery (an artery in the neck). This will help increase blood flow to the brain and prevent strokes.
  • Angioplasty/Stents – Doctors sometimes use a balloon angioplasty and implant steel screens called stents to treat cardiovascular disease. These mechanical devices are used to remove fatty buildup that is clogging the blood vessel.

There are also possible treatments to fix a hemorrhagic stroke. Please consult your physician to learn more.

Rehabilitation after a stroke

Rehabilitation helps stroke survivors relearn skills that are lost when part of the brain is damaged. The types and degrees of disability that follow a stroke depend upon which area of the brain is damaged. Generally, stroke can cause five types of disabilities: Paralysis or problems controlling movement; sensory disturbances including pain; problems using or understanding language; problems with thinking and memory; and emotional disturbances.

For a stroke survivor, the rehabilitation goal is to be as independent and productive as possible. That may mean improving physical abilities. Often old skills have been lost and new ones are needed. It’s also important to maintain and improve a person’s physical condition when possible. Rehabilitation can mean the difference between returning home or staying in an institution.

Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process.